Brodner G, Mertes N, Van Aken H, Pogatzki E, Buerkle H, Marcus M A, Mollhoff T
Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Westfälische Wilhelms-Universität Münster, Germany.
Anesth Analg. 1999 Jan;88(1):128-33. doi: 10.1097/00000539-199901000-00024.
The aim of this prospective, randomized, double-blinded study was to compare pain relief, side effects, and ability to ambulate during epidural anesthesia with ropivacaine 0.2% plus sufentanil versus bupivacaine 0.175% plus sufentanil after major gastrointestinal surgery. Epidural catheters were inserted at T8-11, and 30 microg of sufentanil with 15 mL of ropivacaine 0.75% (Group 1, n = 42) or bupivacaine 0.5% (Group 2, n = 44) was injected. General anesthesia was induced, a continuous epidural infusion (5 mL/h) was then begun with 1 microg/mL sufentanil plus ropivacaine 0.2% (Group 1) or bupivacaine 0.175% (Group 2). Postoperatively, the infusion rate was adjusted to individual requirements. Patients were also able to receive additional 2-mL bolus doses every 20 min. Demographic data (except for gender and height), analgesia, drug dosage, and side-effects, including motor blockade (Bromage score), were similar in both groups, but mobilization recovered more quickly in Group 1. Gender, age, ASA physical status, duration of surgery, and intraoperative blood loss had no effect on mobilization. We conclude that epidural analgesia is effective and safe with both regimens. There is not necessarily a correlation between the Bromage score and the desired outcome of mobilization. The ability to walk postoperatively is hastened if ropivacaine is used instead of bupivacaine.
Regarding pain relief and side effects, epidural analgesia with ropivacaine 0.2% and sufentanil 1 microg/mL yields pain scores and pain intensity comparable to those for the well evaluated combination of bupivacaine 0.175% and sufentanil 1 microg/mL. However, earlier recovery of the ability to walk unassisted in patients receiving the combination of ropivacaine and sufentanil may result in their earlier rehabilitation.
本前瞻性、随机、双盲研究的目的是比较在大的胃肠道手术后，0.2%罗哌卡因加舒芬太尼与0.175%布比卡因加舒芬太尼用于硬膜外麻醉时的镇痛效果、副作用及行走能力。在T8 - 11置入硬膜外导管，注入30微克舒芬太尼与15毫升0.75%罗哌卡因（第1组，n = 42）或0.5%布比卡因（第2组，n = 44）。诱导全身麻醉，然后开始持续硬膜外输注（5毫升/小时），其中含1微克/毫升舒芬太尼加0.2%罗哌卡因（第1组）或0.175%布比卡因（第2组）。术后，根据个体需求调整输注速率。患者还能够每20分钟接受额外的2毫升推注剂量。两组的人口统计学数据（除性别和身高外）、镇痛效果、药物剂量及副作用，包括运动阻滞（布罗麻评分）相似，但第1组的活动恢复更快。性别、年龄、美国麻醉医师协会身体状况、手术持续时间及术中失血对活动恢复无影响。我们得出结论，两种方案用于硬膜外镇痛均有效且安全。布罗麻评分与期望的活动恢复结果之间不一定存在相关性。使用罗哌卡因而非布比卡因可加快术后行走能力的恢复。
在镇痛效果和副作用方面，0.2%罗哌卡因与1微克/毫升舒芬太尼用于硬膜外镇痛产生的疼痛评分和疼痛强度与经过充分评估的0.175%布比卡因与1微克/毫升舒芬太尼组合相当。然而，接受罗哌卡因和舒芬太尼组合的患者更早恢复独立行走能力可能会使其更早康复。
